PROJECT ABSTRACT Laura M. Keohane, PhD, MS is an Assistant Professor in the Department of Health Policy at the Vanderbilt University School of Medicine. As a health services researcher, Dr. Keohane seeks to identify and understand how policy can address health care barriers related to age, disability, and socioeconomic circumstances. This training grant will support her career goal of becoming a leading independent investigator in quality of care for low-income older adults and specifically dual-eligible beneficiaries who have both Medicare and Medicaid coverage. This population includes some of the county's highest-need, highest-cost elderly adults. During the award period, Dr. Keohane will gain additional expertise in qualitative research methods, survey and Medicaid data analysis, and clinical health outcomes for older adults. Her primary mentor, Dr. Melinda Buntin, is a nationally recognized health economist with extensive Medicare policy knowledge, and her co-mentor, Dr. David Stevenson, is a leading expert in end-of-life care and long-term services and supports. Dr. Buntin and Dr. Stevenson will chair an advisory committee of established researchers and clinicians who will provide mentorship in evaluating quality of care for aging populations. Dr. Keohane's training activities will include methods coursework, guided readings on quality of care, and a clinical practicum on health care delivery for older adults. A complementary set of research projects will provide opportunities for Dr. Keohane to apply new skills to investigating an emerging health policy issue for dual-eligible beneficiaries: quality of care in managed care plans. Although over one in four dual-eligible beneficiaries receives Medicare benefits through a managed care plan, there is little evidence demonstrating whether these plans have better health outcomes for older adults with complex health needs and limited socioeconomic resources. To address these gaps, the first aim will use national survey data to compare health and functional status changes over time for dual-eligible beneficiaries in managed care plans versus traditional Medicare. The second aim will employ qualitative data analysis to understand how managed care plans may influence health outcomes by fulfilling quality reporting requirements. The third aim will examine whether improvements in a specific reporting requirement, documenting engagement in advance care planning activities, were associated with better end-of-life outcomes. Finally, the fourth aim will evaluate whether a reduction in Medicaid benefits negatively affected quality of care for dual-eligible beneficiaries and whether participation in managed care plans mitigated this impact. Collectively, the results from these aims will provide evidence that informs important policy decisions about the role of managed care in improving health outcomes for low-income elderly adults. By providing the training necessary to conduct mixed-methods research and to better understand the clinical health needs of aging adults, this award will enable Dr. Keohane to become a successful independent researcher.